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Medical Utilization Review Expert Witnesses

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Richard H. Bailey, MD, CPE, FACP, FAAPL
1411 Maple Hill Rd.
Wassau WI 54403
USA
phone: 715-301-9277
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Richard Bailey Healthcare Quality Control Expert PhotoRichard H. Bailey, MD, CPE, FACP, FAAPL, President and Chief Medical Officer of Bailey Healthcare Solutions, LLC, is American Board Certified in Internal Medicine and a Certified Physician Executive, certified by the Commission of Medical Management.

As an experienced physician executive and skilled clinician, Dr. Bailey is committed to improving the quality and safety of patient care through leadership, innovation, collaboration, and change management. He has more than 15 years of progression physician leadership positions with a strong reputation and demonstrated success in the areas of medical affairs, practice management, physician engagement and alignment, medical informatics, evidence based practice, hospital medicine, health care quality and safety, and utilization management.

Dr. Bailey's services help healthcare organizations refine health care delivery systems for the sole purpose of improving patient care. He is committed to the professional role that physicians have in improving health care quality and patient safety through quality assurance, continuous quality improvement, and total quality management. His work includes peer review, quality review, medical necessity and utilization review for hospitals, third party payers, quality improvement organizations, quality review organizations, and for medico-legal purposes.Litigation Support - Licensed in Wisconsin, New Hampshire and Kentucky, Dr. Bailey provides expert witness services to counsel representing both Plaintiff and Defendant. His services and expertise are available for complicated healthcare matters including:
  • Sentinel Event Investigation
  • Peer Review
  • Case Review
  • Utilization Review
  • Medical Necessity Review
  • Second Opinions
  • Provider Behavior Review
  • Patient Safety / Incident Review
  • Medication Errors
  • Credentialing
  • Medical Staff Governance
  • Distressed Physicians
  • Physician Behavior
  • Quality & Patient Safety
  • Palliative Care
  • Hospital & Medical Staff Relations
  • View Dr. Bailey's Consulting Profile.
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    Sanjiv Modi, MD
    1211 S. Prarie Ave.
    Unit 4901
    Chicago IL 60605
    USA
    phone: 312-450-2475
    fax: 866-597-9162
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    Sanjiv Modi, MD, is board certified in Medical Oncology, Hematology, and Internal Medicine. In active practice since 2000, Dr. Modi has been reviewing medical records for peer review, utilization review, disability review, and medical legal purposes since 2012. He holds an active Florida Expert Witness Certificate.

    Litigation Support - Dr. Modi provides expert witness services for litigation in the specialty of Hematology, Medical Oncology, and Internal Medicine. His services are available to attorneys representing both Plaintiff and Defendant.

    Dr. Modi has been called upon to define applicable standards of care and identify deviations from and adherence to the applicable standards of care. He utilizes objective evidence of standards of care and national published guidelines in preparing his reports.

    Dr. Modi is familiar with court proceedings and the deposition process. He is experienced in trial and able to communicate with a jury in easy to understand language. His service include medical chart review, narrative reports, and testimony for court, arbitrations and medical panels.

    Areas of Expertise:
    • Blood Clots
    • Anticoagulation
    • Cancer
    • Chemotherapy
    • Mesothelioma
    • Clinical Genetics
    • Hospice and Palliative Care
    View Dr. Modi's Consulting Profile.
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    Adam J. Carinci, MD
    9118 Bluebonnet Centre Boulevard
    Baton Rouge LA 70809
    USA
    phone: 845-797-2305
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    Adam Carinci Pain Medicine Expert PhotoDr. Adam J Carinci, MD, is a nationally recognized and sought after clinician, expert witness, and speaker with over a decade of Pain Medicine experience. He is double-board certified in both Anesthesiology and in Pain Medicine.

    Dr. Carinci trained at Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Massachusetts General Hospital, and Harvard Medical School. He is Partner at Comprehensive Pain Management in Baton Rouge, LA. Prior to his current position, he was the Director of the Pain Medicine Center at Massachusetts General Hospital and an Instructor at Harvard Medical School.

    Dr. Carinci has been involved in over 40 cases as an expert witness serving counsel for both plaintiff and defense. He has qualified as an expert witness in federal court. He has authored over 20 expert reports, and has offered testimony under oath at both depositions and trials. Dr. Carinci is pleased to provide attorney references and redacted sample reports.

    Dr. Adam Carinci is an active member of the American Society of Anesthesiologists, The American Academy of Pain Medicine and the American Pain Society. He lectures nationally as an expert on opioids and pain.

    Pain Management Credentials:
    • Board Certification in Anesthesiology (ABMS)
    • Board Certification in Pain Medicine (ABMS)
    • Pain training: Johns Hopkins Hospital and Massachusetts General Hospital / Harvard Medical School
    • Prior Director of the MGH Center for Pain Medicine
    • Practice clinical pain management
    Litigation Support:
    • Highly sought after, extensive expert witness experience
    • Standard of care opinions
    • Translate complex medical issues into easily understood language
    • Assist litigators in case merit
    • Case discussion, document review, expert reports, testimony under oath, trial experience
    Insurance:
    • Independent Medical Examinations
    • Peer Reviews
    • Utilization Review
    • Workers comp expertise: diagnosis, causation, pre-existing injuries, appropriates of care, MMI, impairment ratings, restrictions, return to work
    Training & Education:
    • Training and presentations for insurance companies, nurses, case managers, physician groups, law enforcement
    www.thepainspecialist.com/
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    Matthew Lee
    MD, RPh, MS
    5700 Old Richmond Ave.
    Suite A-5
    Richmond VA 23226
    USA
    phone: 804-358-1492
    fax: 804-358-1491
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    Dr. Matthew Lee is a Physician, Pharmacist, Pharmacologist and Toxicologist who also practices as an Expert Witness and Legal Strategy Consultant.

    Specific Benefits Include:
  • Increased quality and integrity of written expert reports, based on an expanded knowledge base
  • Time savings by only having to coordinate and discuss a case with one expert as opposed to two or more
  • Since there is so much overlap between fields in the medical profession it is often hard to determine where one scope ends and another begins. This ambiguity is dramatically decreased , and scope increased by combining physician, pharmacist, and pharmacologist into one
  • Communication skills of a pharmacist and experience dealing directly with the lay-public, in addition to the knowledge and background of a physician is extremely beneficial describing technical details to a jury
  • Practicing in different realms within the healthcare field has allowed Dr. Lee to integrate the multiple facets giving him a unique and distinct perspective that no other expert has
  • Case Experience Includes:
  • Criminal and Civil Cases
  • Anaphylactic Reactions
  • Overdosel
  • Wrongful Death
  • Cardiac Arrest
  • Respiratory Arrest
  • Fentanyl Overdose
  • Dilaudid Overdose
  • Pharmacist Mis-Fills
  • Pharmacist Dispensing Errors
  • Pharmacy Standard of Care
  • Medication Adverse Effects
  • Falls Related to Medications (in and out of hospital)
  • Toxicology/Toxic Reactions
  • Medical Marijuana
  • Positive Drug Screens in the Workplace
  • Workplace Safety
  • Fit for Duty Testing
  • Dilaudid is a commonly used opioid narcotic analgesic in hospitals due to its potency and effectiveness in the management of acute pain. On occasion, patients may be administered too much Dilaudid resulting in an overdose.

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    Uwe G. Goehlert, MD
    President
    150 Dorset Street
    PMB 201
    South Burlington VT 05403-6256
    USA
    phone: 802-578-8179
    fax: 802-713-1002
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    Uwe Goehlert Health care Expert PhotoUwe Gustav Goehlert, MD, CM, MPH, MBA, FAAFP, FAEP, FACFEI, CHCQM, FAIHQ is Board Certified in Family Practice, Emergency Medicine, Forensic Medicine, Quality Assurance and Utilization Review, Managed Care Medicine, and eligible in Preventive Medicine and Public Health. Dr. Goehlert has been practicing medicine for more than 30 years. He has extensive “hands on” clinical and administrative experience in multiple primary care settings. His broad expertise is in Ambulatory Emergency and Urgent Care Medicine for all age groups.

    Dr. Goehlert has particular interest and expertise in Managed Care Quality and Utilization Management for out of network and out of geographic area benefits. Efficiency of appropriate health care delivery using cutting edge biotechnology and medical informatics technology are his particular emphasis. He continues active clinical practice, administration, medical legal and insurance consulting and teaching. He is currently and actively engaged in medical legal ethics and peer review activities. His engagements include medical legal, insurance, educational, and managed care entities.

    Dr. Goehlert provides Medical-legal and Insurance Review Services to attorneys for both Plaintiff and Defense. His services include document review and second opinion to detailed ongoing litigation support / expert consulting.

    Areas of Expertise:
    • Ambulatory Care
    • Urgent Care
    • Emergency Medicine
    • Insurance Appeals
    • Utilization Reviews
  • Peer Reviews
  • Pre-authorizations
  • Medical Necessity Reviews
  • Travel Medicine
  • Medical Ethics
  • Education: Education: MPH, Johns Hopkins, Baltimore, MD. USA; MSc, MD, CM, McGill University, Montreal, CANADA; MBA, Loyola College, Baltimore, MD. USA

    Memberships and Associations (Selected):
    • American Medical Association
    • American Academy of Family Physicians
    • American College of Emergency Physicians
    • American Board Of Quality Assurance and Utilization Review Physicians
    • American College of Managed Care Medicine
    • American Academy of Urgent Care Medicine
    • American Public Health Association
    • International Society of Travel Medicine
    • American College of Forensic Examiners
    • American College of Physician Executives
    • American College of Legal Medicine
    • American College of Forensic Examiners Institute
    View Dr. Goehlert's Consulting Profile.
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    Huddleston Medical Services, S.C.
    Leon M. Huddleston, MD, JD, CHC, CPHIMS
    11600 S. Kedzie Ave.
    Merrionette Park IL 60803
    USA
    phone: 708-926-9529
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    Leon Huddleston, MD, JD, CHC, CPHIMS, specializes in Physical Medicine and Rehabilitation and Pain Management Medicine. Dr. Huddleston is Certified in Healthcare Compliance (CHC) and a Certified Professional in Healthcare Information and Management Systems (CPHIMS). He earned is Juris Doctor from DePaul University College of Law in 2012.

    Current Positions:
    • Huddleston Medical Services, S.C., Practice Manager (Physician), - Full accountability for all daily operations of a private medical practice for the rehabilitation as well as medical and interventional management of patients with acute and chronic pain syndromes
    • Presence St. Joseph Center for Wound Care and Hyperbaric Medicine, Medical Director - Responsible for implementing the full spectrum of care in the management of chronic and acute wounds in the hospital’s wound care and hyperbaric medicine center
    • Huddleston Legal Consulting Solutions, P.C., Principal - Health Law firm created to advise and support health care providers and entities in navigating the regulatory and legal complexities of the health care system
    Litigation Support - Dr. Huddleston performs credible and unbiased independent medical examinations, medical record, utilization, disability, and workers compensation reviews along with expert testimony for attorneys representing both Plaintiff and Defense. He has been deposed and/or testified over 20 times since 2010.

    Areas of Expertise:
    • Wound Care Management
    • Pain Management
    • Physical Medicine and Rehabilitation
    • Spine Disorders - Neck / Back
    • Nerve Injuries - Carpal Tunnel, Radiculopathies
    • Sports Medicine
  • Overuse Syndromes
  • Sprains / Strains
  • Joint Pain
  • Disability
  • Workers' Compensation
  • Personal Injury Case Review
  • View Dr. Huddleston's Consulting Profile.
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    Gary Saff, MD
    Anesthesiology /Pain Management Consultant
    5353 N Federal Highway
    Suite 301
    Fort Lauderdale FL 33308
    USA
    phone: (954) 772-7552
    fax: (954) 839-6353
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    Gary Saff, MD, an ivy league trained Anesthesia / Interventional Pain specialist and licensed independent medical examiner, is the director of Integrated Pain Solution of South Florida, serving the tri-county area including Dade, Broward, and Palm Beach Counties.

    Prior to his current position, Dr. Saff was the director of pain management services at Cleveland Clinic and a former director at Columbia University’s St. Lukes-Roosevelt Hospital. He is licensed with the American Board of Anesthesiology, the American Society of Pain Management, the American Board of Independent Medical Examiners, and is also licensed in acupuncture.

    Dr. Saff has been offering litigation support services to attorneys for Plaintiff and Defense for over 20 years. He has been deposed over 100 times and retained to testify as an expert witness when necessary. His services include consultation, peer review examination, medical record review, medical utilization review, personal injury, worker's compensation, and trial testimony.

    Areas of Expertise:

  • Cervical Radiculopathy
  • Common Spine Pain
  • Compression Fractures
  • Low Back Pain / Lumbar
  • Radiculopathy / Sciatica
  • Spinal Stenosis
  • Facet Syndrome
  • Failed Back Surgery
  • Spondylosis
  • Spondylolithesis
  • Disc Degeneration
  • Disc Herniations
  • Fibromyalgia
  • Myofascial Pain Syndrome
  • Post Laminectomy Syndrome
  • Nerve Injuries
  • Cancer Pain
  • RSD / CRPS
  • Arthritis
  • Compression Fractures
  • Trigeminal Neuralgia
  • Shingles
  • Musculoskeletal / Sports Injuries
  • Migraines

  • View Gary Saff's Consulting Profile.
    Gary Saff, MD
    There is a "pain crisis" in America today. Desperate, countless numbers of people are seeking treatment for pain, not understanding its source, and where to turn for help. Unresolved pain issues have caused higher insurance premiums, made the work force less productive, and tarnished the "golden years" of retirement. Many physicians are also befuddled as to which treatment options to pursue, while narcotic use has become rampid. This book, written by the highly acclaimed pain management physician, Gary Saff, M.D, offers unique perspectives and insights into solving this dilemma.
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    Eric M. Orenstein, MD
    2600 Ferry Street
    Lafayette IN 47904
    USA
    phone: 765- 448-8154
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    Eric M. Orenstein, MD, is a board-certified fellowship-trained Orthopedic Surgeon specializing in Hip and Knee Replacement Surgery. In practice for 30 years, he is a Clinical Assistant Professor in Orthopedic Surgery at the Indiana University School of Medicine, teaching residents and medical students.

    Dr. Orenstein has been an active member of Indiana University Hospital's Surgery Standards Committee for several years. He is ABIME certified for Independent Medical Examinations (IMEs). Dr. Orenstein has been on several state review panels for potential medical malpractice claims and has performed over 100 file reviews including disability reviews and utilization reviews.

    Areas of Expertise:
    • Hip & Knee Replacements
    • Forensic Orthopedics
    • Workers' Compensation
    • Impairment Evaluations
  • Medical / Legal Evaluations
  • Causation
  • Utilization Review
  • Peer Review
  • View Dr. Orenstein's Consulting Profile.
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    Dr. Mark Levin
    6 Gel Court
    Monsey NY 10952
    USA
    phone: 845-406-2183
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    Dr. Mark Levin, MD, is an Academic Physician with a wide range of experience in various practice settings, including academia, teaching hospital and private practice settings. He has a consulting practice in clinical standards and utilization review in Oncology and runs a blog devoted to Standards of Care. He is in active medical practice.

    Services Include:
    • Administrative Medicine
    • Brain Tumors
    • Breast Cancer
    • Cancer - Missed Diagnosis
    • Chemotherapy
    • Experimental / Investigational Medicine
    • Hematology
    • Improper Diagnosis
    • Kidney Cancer
    • Lung Cancer
  • Medical Practice Guidelines
  • Medical Records Review
  • Medical Utilization Review
  • Mesothelioma and other Asbestos Lung Diseases
  • Oncology
  • Pain Management
  • Prognosis (Cancer)
  • Standard of Care
  • Tumor Marker Testing
  • 12/26/2012 · Robots & Robotics
    Safe and effective chronic opioid therapy for chronic cancer related pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion.

    Breast cancer patients often suffer menopausal symptoms, which include vaginal dryness. This distressing symptom is often treated with topical estrogen or progesterone creams; however, there remains a concern about systemic absorption of estrogen and its effect on breast cancer. In a group that is treated with tamoxifen, it would appear that the systemic affect would be negated by the tamoxifen's anti-estrogen blockade but the question remains hotly debated.

    4/3/2009 · Medical
    Breast cancer is a malignant (cancerous) growth that begins in the tissues of the breast. Over the course of a lifetime, one in eight women will be diagnosed with breast cancer

    9/23/2008 · Medical
    Acceptance and compliance with screening and genetic programs for genetic illness depends crucially on the compatibility and fit of their design with the social, cultural and religious concerns and mores of target communities. As a case in point, genetic screening programs that are currently in use within Jewish populations are considered on the background of ethical and religious concerns

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    1500 Walnut St.
    Ste. 902
    Philadelphia PA 19102
    USA
    phone: 215-731-1901
    fax: 215-731-9503
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    Richard M. Sobel, MD, DFAPA, has over 30 years of experience practicing Adult Psychiatry and Pain Management / Medicine. His specialty focus is in Pain Medicine, for which he has sub-specialty board certification, Psychotherapy, and Psychopharmacology.

    Dr. Sobel is currently a Clinical Assistant Professor in the Department of Psychiatry at Jefferson Medical School. A Distinguished Fellow of the American Psychiatric Association, Dr. Sobel is immediate Past President and continues to serve on the board of the Greater Philadelphia Pain Society, one of six regional chapters of the American Pain Society. He is a Councilor for the Philadelphia Psychiatric Society and Representative of the Pennsylvania Psychiatry Society to the Safe and Effective Prescribing Practices and Pain Management Work Group of the Pennsylvania Department of Drug and Alcohol Programs.

    In 2014, Dr. Sobel was the recipient of the Dean's Award for Excellence in Education at Jefferson Medical College and, in 2013, was nominated Practitioner of the Year by the Philadelphia Psychiatric Society.

    Litigation Support - Dr. Sobel offers expert witness services to counsel representing both plaintiff and defendant. With voice training for public speaking, he is able to effectively communicate with judge and jury. Dr. Sobel's services include Independent Medical Exams (IMEs), medical record review, utilization review, written reports, depositions, and trial testimony as needed.

    Areas of Expertise:
    • Psychopharmacology
    • Worker's Compensation
    • Post Traumatic Stress Disorder (PTSD)
    • Sleep Disorders
    • Depression
    • Anxiety
  • Complex Regional Pain Syndrome
  • Neuropathic Pain
  • Trauma
  • Opioids
  • Addiction
  • Pain Medication
  • View Dr. Sobel's Consulting Profile.
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    Dr. Stephen M. Raffle
    Principal
    35 Wolfe Grade
    Kentfield, CA 94904
    Also
    Oakland CA 94612
    USA
    phone: 415-461-4845
    fax: 415-461-4039
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    NORTHERN CALIFORNIA
    North of San Francisco
    35 Wolfe Grade
    Kentfield, CA 94904
    (415) 461-4845
    Oakland
    300 Frank H. Ogawa Plaza,Suite 700
    Oakland, CA 94612
    (510) 465-3300

    NATIONWIDE / INTERNATIONAL, has over 43 years of experience offering his expert opinion in Federal and State jurisdictions nationwide. Dr. Raffle has consulted for attorneys, insurers, employers and judges. His track record and experience is impressive: over 5000 psychiatric evaluations, 700+ depositions, 150+ trials, a successful clinical practice, teaching career at U.C. Medical School, and Hastings College of the Law postgraduate course "Trial and Appellate Advocacy" for 11 years instructing attorneys about the direct and cross-examination of expert witnesses.

    Stephen M. Raffle, M.D. and Associates' expertise includes, but is not limited to the following:
    • Chronic Pain
    • Psychosomatic Medicine
    • Post-Traumatic Stress Disorder
    • Psychogenic Pain
    • Traumatic Brain injury and other Dementias
    • False Memory Syndrome
    • Malingering
    • Emotional Distress: Intentional & Unintentional infliction
    • Emotional Distress: Evaluation of
    • Fitness For Duty
    • Risk/Threat Workplace Violence Assessment
    • Wrongful Termination
    • Discrimination (ADA, Title VII, EEOC)
    • Harassment (sexual, etc.)
  • Employment Litigation
  • Medical Malpractice
  • Substance Abuse
  • Testamentary Capacity
  • Undue Influence (including Cults)
  • Toxic Exposure
  • Catastrophic Injury
  • Temporary and Permanent Disability
  • Need for Treatment
  • Sexual Molestation
  • Medical Records Review
  • Assist in Preparation for Direct and Cross-examination of Expert Witnesses and Deposition of expert witnesses
  • Licensed in California.
    12/3/2014 · Psychiatry
    In order for a medical opinion to be admissible as evidence in civil, criminal and administrative cases, the basis of the opinion must fulfill either the Daubert Criteria or the Frye test, depending on the jurisdiction. The judge of the court rules on the admissibility of the expert opinion. The effect of Daubert has been to limit expert testimony to opinions which are based on a scientific foundation. Daubert specifies that adequate scientific support and method and a known error rate must exist. The testimony of a mental health expert rendering an opinion using criteria which does not meet Daubert standards is weakened by the implication that it is not based on "sound science." In some instances, for example, a mental health expert uses an approach where there are no peer-reviewed studies or methods, such as when psychologists compose their own neuropsychological test batteries. In most cases where an attorney is considering a "Daubert challenge," a contemporaneous and up-to-date literature search is indicated. Also, extensive case law presently exists as to specific issues. Being familiar with the Daubert criteria enhances effectiveness in challenging a mental health expert's opinion, whether on voir dire or cross examination. On direct examination, the strengths of an opinion reached under Daubert criteria become a "teaching moment" for the trier of fact, because it will be founded on the science of mental health assessment.

    10/27/2014 · Psychiatry
    Undue influence occurs when the testator's freewill and freedom of choice in the disposition of the assets of his or her estate is replaced by the substituted judgment/wishes of another. This can apply to creating a will, codicil to amend a will, trust or other legal instrument.

    2/11/2014 · Psychiatry
    The medical expert cannot express an opinion about the ultimate question to the trier of fact: how much is the plaintiff's emotional distress (emotional injury) worth in dollars? Yet when the question of these monetary damages is put to a jury, their deliberations are better-served if considered in the context of a Forensic Psychiatrist's knowledgeable findings and testimony.

    5/28/2009 · Human Factors
    All psychiatric reports evaluate something, but not always the same thing. For example, eligibility for benefits, or fitness to do a job. To make sense of the report, the reader must determine what is being evaluated and how it is being done

    5/28/2009 · Psychiatry
    In civil cases where emotional distress is alleged, it often occurs that the plaintiff’s attorney designates the treater as his expert. Usually the argument is that the plaintiff’s own therapist has spent many more hours with the plaintiff than the defense expert and therefore "knows" the plaintiff better. The treater often agrees with this reasoning